CIED malfunction in patients receiving radiation is a rare event that could be detected by remote monitoring.

Introduction: An increasing number of patients with cardiac devices require radiation therapy for treatment of a variety of cancers. This study aimed to identify the incidence and predictors of cardiac implantable electronic devices (CIED) malfunction in a real-world population that has received radiation therapy.

Methods: This retrospective cohort study included 109 adult patients who received radiation therapy at the University of Rochester Medical Center, Radiation Oncology Department, between 2000 and 2015.

Predictors of mortality in patients hospitalized for congestive heart failure with left ventricular ejection fraction ≥ 40.

Background: There are limited data regarding the predictors of mortality in patients with acute congestive heart failure (CHF) and left ventricular ejection fraction (LVEF) ≥ 40%.

Methods: We evaluated clinical characteristics, mortality and prognostic factors in a sample of consecutive patients hospitalized for CHF with LVEF ≥ 40%. Multivariable Cox regression models were developed to predict mortality using baseline clinical characteristics and echocardiographic variables.

Comparison of low versus high (>40 mm Hg) pulse pressure to predict the benefit of cardiac resynchronization therapy for heart failure (from the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy Trial).

Low pulse pressure (PP) is associated with poor outcome in hospitalized patients with systolic heart failure (HF). However, the relation between PP and response to cardiac resynchronization therapy with defibrillator (CRT-D) is unknown. We aimed to evaluate the relation between preimplantation PP and echocardiographic response to CRT-D and subsequent clinical outcome after 1 year.

End-of-life care in patients with implantable cardioverter defibrillators: a MADIT-II substudy.

Background: Implantable cardioverter defibrillator (ICD)-delivered shocks can cause substantial distress, warranting consideration of ICD deactivation at end of life. This study was designed to describe the patterns of end-of-life management in patients with ICDs.

Methods: There was a retrospective chart review of 98 patients who died in the ICD arm of multicenter automated defibrillator implantation trial II (MADIT II).

Underutilization of Implantable Cardioverter Defibrillator in Primary Prevention of Sudden Cardiac Arrest.

Background: The aim of this study was to evaluate the overall use of implantable cardioverter defibrillators (ICD) for primary prevention of sudden cardiac arrest (SCA), among eligible patients from an outpatient cardiology clinic and to determine what factors might contribute to underutilization of ICDs.

Methods: This report was a retrospective chart review of patients with ischemic or non-ischemic cardiomyopathy and left ventricular ejection fraction ≤ 35% from an outpatient cardiology practice from January 2005 to May 2008. These patients met the eligibility criteria for ICD implantation for primary prevention of SCA.

Physicians' knowledge and attitudes regarding implantable cardioverter-defibrillators.

Background: Information is limited regarding the knowledge and attitudes of physicians typically involved in the referral of patients for implantable cardioverter-defibrillator (ICD) implantation.

Methods: We conducted a survey of primary care physicians and cardiologists at the University of Rochester Medical Center and the Unity Health System Rochester, NY from December 2008 to February 2009. The survey collected information regarding physicians' knowledge of and attitudes towards ICD therapy.

Effect of biventricular pacing during a ventricular sensed event.

Loss of biventricular (BiV) pacing occurs during ventricular sensed events such as frequent ventricular ectopy, nonsustained ventricular tachycardia, and intrinsic atrioventricular nodal conduction, such as in atrial fibrillation. Ventricular sense response (VSR) pacing, a novel cardiac resynchronization therapy pacing strategy, maintains BiV pacing during these sensed ventricular events. Patients who underwent echocardiographic optimization after BiV pacemaker implantation were enrolled, and aortic velocity-time integrals (VTIs) were recorded and compared during intrinsic conduction without pacing, optimized BiV pacing, and intrinsic conduction with VSR pacing alone.

Permanent pacemaker implantation via left superior vena cava without communication with the coronary sinus.

The persistence of the left superior vena cava is a rare venous anomaly and usually does not produce hemodynamic disturbances. Left sided cardiac device implantation has increased the awareness of this rare anomaly. In most cases, left superior vena cava connects to the right heart via coronary sinus.

Physicians' preferences and attitudes about end-of-life care in patients with an implantable cardioverter-defibrillator.

Clinical guidance is deficient regarding deactivation of implantable cardioverter-defibrillators (ICDs) in patients with terminal illnesses. We hypothesized that many physicians are apprehensive about discussing ICD deactivation with their dying patients. Thus, we conducted an anonymous survey of all the physicians in the Department of Medicine at Unity Health System in Rochester, NY.

Moxifloxacin-induced torsades de pointes.

Torsade de pointes (TdP) is increasingly recognized as a complication of drug therapy. The most common cause of drug-induced QT prolongation is inhibition of the rapidly activating component of the delayed potassium current (I(Kr)). Moxifloxacin, a widely used fluoroquinolone, is a weak I(Kr) inhibitor and has been associated with QT prolongation.

Defibrillation coil reversal: a rare cause of abnormal noise and inappropriate shocks.

We report a rare case of inadvertent reversal of the defibrillator shock coils during generator change which then resulted in both intermittent, recurrent "noise" on both the rate sensing and the shock electrogram leads and multiple inappropriate shocks.

Dofetilide-induced long QT and torsades de pointes.

Dofetilide, a new class III antiarrhythmic agent, has been approved as an antiarrhythmic agent for the treatment of atrial fibrillation and atrial flutter. Dofetilide selectively inhibits the rapid component of the delayed rectifier potassium current resulting in a prolongation of the effective refractory period. Like other drugs that affect potassium currents, the prolonged QT interval occurring in the patients treated with dofetilide can be complicated by torsades de pointes.

Update on implantable cardioverter defibrillator trials.

Many randomized trials of implantable cardioverter defibrillator (ICD) therapy versus medical treatment for the prevention of death in survivors of cardiac arrest or in patients at high risk of sudden cardiac death (SCD) have been reported. ICD therapy has been consistently efficacious in preventing SCD. ICD therapy has generally favorably impacted total mortality, but this has depended upon the control group's risk for arrhythmic and nonarrhythmic mortality.